Study of osteomyelitis: utility of combined histologic and microbiologic evaluation of percutaneous biopsy samples.

PURPOSE

To determine the utility of combined histologic and microbiologic evaluation of percutaneous biopsy samples in cases of suspected osteomyelitis.

MATERIALS AND METHODS

Twenty-five patients with suspected osteomyelitis were prospectively studied over a 1-year period. With usual trephine techniques under radiologic guidance, core and aspiration biopsy samples were obtained in each patient for both histologic and microbiologic analyses.

RESULTS

Sixteen biopsy specimens demonstrated histologic evidence of osteomyelitis. Of these, eight were also culture positive. Seven of the eight culture-negative, histologically positive cases were interpreted as chronic osteomyelitis. In no patient were cultures positive and histologic findings negative. Three of 19 patients with proved osteomyelitis had negative histologic and microbiologic findings. The sensitivity of culture in the diagnosis of osteomyelitis in our study was 42%; the sensitivity of both culture and histologic findings was 84%.

CONCLUSION

Although the volume of a biopsy specimen is a major determinant of culture yield, a portion of a percutaneous biopsy sample should be histologically evaluated for possible osteomyelitis.